LBBC Believes ACS Recommendations Add to Confusion
On October 20, the American Cancer Society (ACS) issued updated breast cancer screening guidelines. These recommendations included increasing the age to start mammogram screenings from 40 to 45 in healthy women at average risk for breast cancer. In addition, the new guidelines increase the time between screenings for women over 55 at average risk from once per year to once every two years.
ACS suggests women understand their individual risk due to family history, age and other factors, and after weighing those risks, decide with their doctors at what age and what frequency they should begin to have mammography. Two other well respected organizations, the National Comprehensive Cancer Network and the U.S. Preventive Services Task Force (USPSTF), recommend mammograms begin at age 40 and 50 respectively.
Living Beyond Breast Cancer believes the ACS recommendations add to the confusion around a test that has been widely promoted and accepted as a method that saves lives through early detection. LBBC supports a woman making an individualized decision with her doctor, but we are deeply concerned that insurance companies may use these age and frequency recommendations to deny coverage of mammograms to women who may be at high risk for breast cancer death because of factors other than family history. Lower income Americans who are less likely to have this kind of conversation with their health care provider and may be at increased risk may not be informed they have the option to be screened, assuming insurance coverage does exist. And if insurance will not cover the test, these women are less likely to be able to afford the mammograms.
Earlier this summer, Living Beyond Breast Cancer joined with other patient advocacy organizations to call for a 2-year moratorium on the draft USPSTF guidelines that raise the age to begin breast screening to 50 years old. The grades assigned to the USPSTF recommendations are used to set federal insurance coverage, and private insurance usually follows. It is unclear when the USPSTF will finalize its guidelines. There is a bipartisan bill pending in Congress called the Protecting Access to Lifesaving Screenings (PALS) Act, which would place a 2-year moratorium on implementing the USPSTF breast cancer screening recommendations. This 2-year “time out” would provide the necessary time for a review of the research and to have a thoughtful public discussion about whether changes need to be made.
Today, judging individual risk for breast cancer is not perfectly understood, and the tools we have for detecting breast cancer early are not as effective as they need to be. All these factors make screening decisions complicated and confusing for consumers. LBBC believes all patient advocacy groups should double their educational efforts to help women make informed decisions in consultation with their healthcare providers, and that insurance covers routine screenings for healthy women at age 40 and over.